<div class=grid_18>
<div class=grid_10> 
    <div class=block-border> 
        <div class=block-header> 
            <h1>SDA Church - Kwabrafoso: Enter Baby Dedication</h1><span></span> 
        </div> 

        <form id=validate-form class="block-content form" action="add" method=post>
                      
            <div class=_50> 
                <p><label for=textarea>Baby Dedication No</label> 
                    <input id="bdid" name="bdid" class="required" class="input-xlarge" type="text" value=""/></p> 
            </div>  
                
            <div class=_50> 
                <p><label for=textarea>Baby's First Name</label>
                    <input id="bfname" name="bfname" class="required" type="text" value=""/></p> 
            </div>

            <div class=_50> 
                <p><label for=textarea>Baby's Middle Name</label>
                    <input id="bmname" name="bmname" class="required" type="text" value=""/></p> 
            </div>

            <div class=_50> 
                <p><label for=textarea>Baby's First Name</label>
                    <input id="bfname" name="bfname" class="required" type="text" value=""/></p> 
            </div>

            <div class=_50> 
                <p><label for=datepicker>Baby's Date of Birth</label>
                    <input id="dob" name="dob" class="required" type="text" value=""/></p> 
            </div>

            <div class=_50> 
                <p><label for=textarea>Father's Name</label>
                    <input id="fatname" name="fatname" class="required" type="text" value=""/></p> 
            </div>

            <div class=_50> 
                <p><label for=textarea>Mother's Name</label>
                    <input id="motname" name="motname" class="required" type="text" value=""/></p> 
            </div> 

            <div class=_50> 
                <p><label for=textarea>Officiating Minister</label>
                    <input id="offmin" name="offmin" class="required" type="text" value=""/></p> 
            </div>

            <div class=_50> 
                <p><label for=textarea>Birth Certificatte No</label>
                    <input id="bcno" name="bcno" class="required" type="text" value=""/></p> 
            </div>

            <div class=_50> 
                <p><label for=textarea>Baby's eFile</label>
                    <input id="efile" name="efile" class="required" type="blob" value=""/></p> 
            </div>            

            <div class=block-actions> 
                <ul class=actions-left> 
                    <li><a class="button red" id=reset-validate-form href="javascript:void(0);">Reset</a></li> 
                </ul> 

                <ul class=actions-right> 
                    <li><input type=submit id="Save-Baby Dedication " class="button" value="Save Record"></li> 
                </ul> 
            </div> 
        </form> 
    </div> 
</div> 